Background and Aims

Contrast harmonic EUS (CH-EUS) has the ability to depict tumor microvasculature. Decreased microvascular density has been identified as a factor associated with tumor aggressiveness. We aimed to study the accuracy of CH-EUS for the prediction of pancreatic neuroendocrine tumor (PNET) aggressiveness.

Methods

Between June 2009 and March 2015, all consecutive patients with histology-proven PNETs and CH-EUS examination were included. Nine endosonographers blindly analyzed all videos. CH-EUS tumor aggressiveness was defined as a heterogeneous enhancement at the early arterial phase. The final diagnosis of tumor aggressiveness was defined as follows: G3 tumors, morphologic and/or histologic findings of metastatic disease in G1/G2 tumors. Diagnostic values were calculated. Intratumoral microvascular density and fibrosis were assessed on pathologic specimens.

Results

Eighty-one tumors were included, of which 26 were aggressive (32.1%). In CH-EUS 35 tumors (43.2%) had a heterogeneous enhancement. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CH-EUS for the diagnosis of tumor aggressiveness were 86%, 96%, 82%, 71%, and 98%, respectively. The interobserver agreement among the 9 endosonographers was good (k = .66). The intraobserver agreement was excellent for the junior (κ = .83) and senior (κ = .82) endosonographers. Heterogeneous tumors at CH-EUS corresponded to fewer vascular and more fibrotic tumors (P < .01).

Conclusions

CH-EUS is accurate in the prediction of PNET aggressiveness and could be a decision-making element in their management.

中文翻译：

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对比谐波EUS预测胰腺神经内分泌肿瘤的侵袭性（视频）

背景和目标

对比谐波超声内镜（CH-EUS）具有描绘肿瘤微脉管系统的能力。微血管密度的降低已被确定为与肿瘤侵袭性相关的因素。我们旨在研究CH-EUS预测胰腺神经内分泌肿瘤（PNET）侵袭性的准确性。

方法

在2009年6月至2015年3月之间，纳入了所有经组织学验证的PNET和CH-EUS检查的连续患者。九名内窥镜检查员盲目分析了所有视频。CH-EUS肿瘤侵袭性定义为早期动脉期的异质性增强。肿瘤侵袭性的最终诊断定义如下：G3肿瘤，G1 / G2肿瘤中转移性疾病的形态学和/或组织学发现。计算诊断值。在病理标本上评估肿瘤内微血管密度和纤维化。

结果

其中包括了81个肿瘤，其中26个是侵袭性的（32.1％）。在CH-EUS中，有35个肿瘤（占43.2％）具有异质性增强。CH-EUS诊断肿瘤侵袭性的总体准确性，敏感性，特异性，阳性预测值和阴性预测值分别为86％，96％，82％，71％和98％。9名超声内窥镜检查者之间的观察员之间的一致性很好（k = .66）。对于初级（κ= .83）和高级（κ= .82）内窥镜检查人员，观察者内部协议非常好。CH-EUS的异质性肿瘤与较少的血管瘤和更多的纤维化肿瘤相对应（P  <.01）。

结论

CH-EUS在预测PNET攻击性方面是准确的，并且可能是其管理中的决策要素。